The short-stay antipsychotic measure counts residents who were not on an antipsychotic on their first assessment but show one on a later assessment in the same episode. One checked N0415A1 after the first assessment puts the resident in the numerator, and nothing later in the episode takes them out.
What it measures
This is the Percent of Residents Who Newly Received an Antipsychotic Medication (short stay), CMS ID N011.03, specified in Table 2-10 of the MDS 3.0 QM User’s Manual v18.0. It is built from the MDS alone and is not risk-adjusted. It covers every short-stay resident, not only Medicare Part A: an episode with 100 or fewer cumulative days in the facility at the end of the target period. Five-Star scores it as one of the six short-stay measures, worth up to 100 points. Lower is better.
It is a different measure from the long-stay antipsychotic measure, which CMS re-specified in January 2026 to add Medicare and Medicaid claims and encounter data. The short-stay one still reads only N0415A1. (CMS’s change tables for the October 2026 RAI Manual, v1.20.11, list no changes to Section N.)
The two assessments that matter
The measure compares the resident’s initial assessment with the rest of the episode.
- Initial assessment: the earliest assessment on or after the admission entry that is an OBRA Admission (A0310A = 01), a 5-Day PPS (A0310B = 01) or an OBRA Discharge (A0310F = 10 or 11), and no more than 130 days before the target assessment.
- Target assessment: the latest assessment in the episode that is an OBRA assessment (A0310A = 01 to 06), a 5-Day or an OBRA Discharge, within 120 days of the end of the episode.
They must be two different assessments.
“If the same assessment qualifies as both the initial and target assessments, it is used as the target assessment and the initial assessment is considered to be missing.”
A resident with only one qualifying assessment in the episode is therefore not in the measure at all. For a typical Medicare admission, the initial assessment is the 5-Day (on its own or combined with the OBRA Admission) and the target is the discharge.
What puts a resident in the numerator
“Short-stay residents for whom one or more assessments in a look-back scan (not including the initial assessment) indicates that antipsychotic medication was received.”
The look-back scan is the target assessment plus every qualifying assessment before it in the episode. So a Yes on any of them, other than the initial one, counts, even if the drug was stopped and the discharge says No. On each assessment, N0415A1 is checked if an antipsychotic was taken at any time in the 7-day look-back, or since admission or reentry if that was less than 7 days.
A hospital return doesn’t start over. A reentry within 30 days continues the same episode; only a new admission entry begins a new one.
Who is left out
- The initial assessment already codes an antipsychotic (N0415A1 checked) or leaves it as a dash. Those residents were not “newly” receiving one.
- N0415A1 is a dash on every assessment in the scan after the initial one.
- Schizophrenia (I6000), Tourette’s syndrome (I5350) or Huntington’s disease (I5250) on any assessment in the scan.
The diagnosis exclusions have to be real. CMS audits schizophrenia coding, and Five-Star suppresses a building’s short-stay QM rating for six months when an audit finds coding inaccuracies (with further penalties on the long-stay side).
The classification rule that catches people out
N0415 is coded by what the drug is, not what it was ordered for. That puts some common antiemetics in the measure.
“Medications that have more than one therapeutic category and/or pharmacological classification should be coded in all categories/classifications assigned to the medication, regardless of how it is being used. For example, prochlorperazine is dually classified as an antipsychotic and an antiemetic. Therefore, in this section, it would be coded as an antipsychotic, regardless of how it is used.”
Two more rules from the same page: a medication is coded even if it was given only once in the look-back, and a dose given while the person is a resident counts wherever it was given, including a hospital emergency room. A combination tablet that contains an antipsychotic is coded as an antipsychotic.
A worked example. Resident C is admitted after a hospital stay for pneumonia, on no antipsychotic. The 5-Day leaves N0415A1 unchecked. On day 12, prochlorperazine is ordered for nausea and given for three days. The OBRA Admission assessment, with its ARD on day 14, has those doses in its 7-day look-back, so N0415A1 is checked. Resident C is in the numerator for the episode, though no one on the unit thought of the order as an antipsychotic. Knowing the rule ahead of time gives the team a chance to ask the prescriber and pharmacist whether a different antiemetic would suit the resident.
Common coding mistakes
- Missing an antipsychotic the resident arrived on. If the initial assessment says No and the next one says Yes, CMS reads the resident as newly receiving it.
- Leaving prochlorperazine or another dually classified drug off N0415A1 because it was ordered for something else.
- Missing a dose given in the emergency room while the person was a resident.
- Coding I6000 without the documentation to support schizophrenia.
- Leaving N0415A1 blank on the initial assessment. A dash there removes the resident from the measure, and it misstates the record; code what was given.
- Counting a long-acting injection that wasn’t given inside the look-back. It is coded only if it was administered in the 7 days.
See your building’s short-stay antipsychotic rate, free.
How Five-Star scores it
Five-Star averages four quarters, weighting each by its number of residents, and scores the measure by quintile, 20 to 100 points. Like the short-stay pressure ulcer measure, a rate of zero earns the full 100, because more than 20 percent of buildings report zero.
| Rate | Points |
|---|---|
| 0% | 100 |
| 0.01% to 0.96% | 80 |
| 0.97% to 1.68% | 60 |
| 1.69% to 2.89% | 40 |
| 2.90% or higher | 20 |
The bands are narrow. If the four quarters hold 150 short-stay residents between them, one resident in the numerator is about 0.7%, enough to go from 100 points to 80, and three put the building at 40.
SuperQM flags a resident admitted on an antipsychotic, prochlorperazine included, whose admission MDS hasn’t coded it, so the measure counts only the residents who were really new to one.
Sources
- MDS 3.0 Quality Measures User’s Manual v18.0 (effective January 1, 2026), Chapter 1 and Table 2-10
- MDS 3.0 RAI User’s Manual v1.20.11 (October 2026), Chapter 3, Section N (N0415)
- Nursing Home Five-Star Quality Rating System: Technical Users’ Guide, September 2026, Table 4, Scoring Exceptions and Appendix Table A3
